Paediatric trauma - NAI Flashcards
what are the most common types of fractures in children?
Greenstick AND Salter-harris.
3 typical sx/sy of a fracture
pain, swelling, deformity
4 aspects of Mx
xray, rest, ice, compress, elevate, plaster cast.
PRICEM – protected weight bearing, rest, ice, compression, elevation, medication’s (analgesia, NSAID’s) and if these don’t work then consider surgery. Use PRICEM pneumonic to remember the conservative Mx
advice to patients to help prevent further accidents
encourage regular exercise, healthy diet, wear safety equiptment, appropriate supervision.
what are the Fracture principles for children?
- childrens. Fractures are often simple, incomplete and quickly heal. (metabolically active periosteum, cellular bone, plastic, don’t overtreat or over mobilise, fixation isnt usually required)
- remodel well in the plane of joint movement (appositional periosteal growth, differemtial physeal growth).
- a thick periosteal hinge is usually a friend.
- fractures involving physes can result in progressive deformity.
types of forarm fractures
shaft, galeazzi, monteggia, distal radial
on assessment
hx of mechanism of injury, deformity, soft tissue involvement - wounds, sensation, vascular status
complications of forearm fracture?
compartment syndrome (volkmanns), nonunion, refracture, radioulnar synostosis, PIN injury, superficial radial nerve injury.
distal radius buckle, torus…
failure of 1 cortex in compression
distal radius greenstick
failure of 1 cortex in compression and the other cortex in extension, looks like someones been winded.
Mx
Cast
ddx for a knee trauma
infection, inflammatory arthropathy, neoplasm, apophysitis, hip, foot, sickle, haemophilia.
where does physeal injury commonly occur
Distal femur below physis –Prox tibia below physis
how is physeal arrest mx
Resect Bar, Complete epiphysiodesis, Contralateral epiphysiodesis, Corrective osteotomy
outline a tibial spine fracture…
Overlap with ACL • Meyers & McKeever – I Undisplaced – II Hinged – III Displaced
ogden types of tibial tubercle
• Ogden classification: – I Distal avulsion – II To prox tibial physis (not joint) – III To prox tibial physis (into joint)
patellar dislocation
• Risk factors: Laxity, Poor VMO, Q angle, Femoral anteversion, Tibial ext rotation, Patella alta. tx = Cast 2/52 - Repair medial ligament
–Mobilise - Lateral release
–VMO exercises - Medialise tibial tubercle
ankle fractures
Physis as plane of fracture • Physis weaker than Ligaments • Growth arrest risk History – Mechanism • Deformity • Soft tissues • AP & lateral radiographs – Ottawa rules Management - ORIF, - Monitor for growth arrest
transitional ankle fractures
- Tillaux: – External rotation, – anterior tibiofib lig avulsion, – SH3, – Closed/Open reduction
- Growth plate closing, age 13-14y: –Central>Medial>Lateral fusion, –Articular congruity over Physeal, integrity Triplane, – External rotation, – SH3 on AP + SH2 on lat = SH4, – 2 - 3 - 4 part, – CT, ORIF
name some overuse injuires
Osgood-Schlatter’s Disease, Sever’s Disease.
Osgood–Schlatter disease is inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful bump just below the knee that is worse with activity and better with rest.
what is a salter harris fracture?
A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. It is thus a form of child bone fracture. It is a common injury found in children, occurring in 15% of childhood long bone fractures.
